Attitude and Practice Toward Use of Cigarettes and Electronic Cigarettes Among Pregnant Women: A Questionnaire-Based Survey.

OBJECTIVE: This study aimed to evaluate attitude and practice toward use of regular tobacco cigarettes and electronic cigarettes among pregnant women. MATERIAL AND METHODS: A total of 1123 pregnant women participated on a voluntary basis in this questionnaire survey. Maternal characteristics, cigarette consumption parameters, and personal opinions regarding the adverse effects of smoking during pregnancy were evaluated. RESULTS: Active smokers composed 12.4% (9.4%: regular tobacco cigarettes, 3.0%: electronic cigarettes) of the study population. Smoking during the current pregnancy, particularly via regular tobacco cigarettes, was more likely for women with smoking during previous pregnancies (56.0% vs. 7.8%, P < .001), previous history of low birth weight infant delivery (16.1% vs. 8.6%, P = .013), premature delivery (16.7% vs. 7.0%, P < .001), and stillbirth (22.8% vs. 11.7%, P = .002). The presence versus absence of smoking during pregnancy was associated with a lower likelihood of being a housewife (70.5% vs. 80.5%, P = .010) and a higher likelihood of having an actively smoking mother (25.9% vs. 11.2%, P < .001) or partner (65.7% vs. 46.9%, P < .001). Regular tobacco cigarette users considered electronic cigarettes to have a higher risk of adverse impacts (11.1% vs. 2.9%, P = .012), while electronic cigarette users considered regular cigarettes to have a higher risk of nicotine exposure (55.9% vs. 13.0%, P < .001). CONCLUSION: Our findings indicate being employed, having an actively smoking mother or partner, as well as smoking in previous pregnancies, to be the risk factors for increased likelihood of smoking during pregnancy.

Cushing's syndrome due to adrenocorticotropic hormone-secreting metastatic neuroendocrine tumor of unknown primary origin: a case report and literature review.

BACKGROUND: In this article, we present a case of neuroendocrine neoplasm of unknown primary origin (UPO NEN), which is a rare cause of ectopic Cushing's syndrome (ECS) presenting numerous challenges, together with a literature review. CASE REPORT: A 43-year-old male patient presented with clinical features consistent with Cushing's syndrome (CS) and adrenocorticotropic hormone (ACTH)-dependent hypercortisolemia. Despite a suspicious lesion on pituitary MRI, the high-dose dexamethasone suppression test and bilateral inferior petrosal sinus sampling results were not compatible with Cushing's disease. Bilateral non-homogeneous opacities were observed in the thorax CT of the patient, who also had a history of COVID-19 infection, but no tumoral lesion was detected. When 68Ga-SSTR PET/CT and 18FDG-PET/CT were performed, multiple metastatic foci were detected in mediastinal and hilar lymph nodes and the axial skeleton. Paratracheal-subcarinal lymph nodes were excised mediastinoscopically, and the diagnosis of NEN was made. Histopathological findings indicated that the possible origin was an atypical pulmonary carcinoid with a low Ki-67 labeling index. After controlling hypercortisolemia, a regimen of somatostatin analogs and capecitabine plus temozolomide was decided upon as treatment by a multidisciplinary council. CONCLUSION: This is a challenging case of UPO NEN presenting with ECS and confounding factors, such as previous infection and incidental lesions, during the diagnosis process. The case in question highlighted the fact that atypical pulmonary carcinoid with a low proliferation index may cause visible metastases even when radiologically undetectable.

The use of new oral anticoagulants in geriatric patients: A survey study for physicians.

INTRODUCTION: The use of new oral anticoagulants (NOACs) for the treatment of thromboembolic diseases is becoming more widespread. The present study brings together the opinions and daily routine clinical practices of physicians regarding the use of NOACs in the geriatric age group for the treatment of venous thromboembolic diseases. MATERIALS AND METHODS: The study accessed 274 physicians (197 attending, 70 resident and seven primary care physicians) with various specialties and academic positions through face-to-face interviews or e-mails, and asked them to complete a questionnaire form prepared for NOAC use on a voluntary basis between 1 May and 31 December 2019. RESULT: It was found that physicians preferred NOACs mostly for patients contraindicated for the regular use of low-molecular-weight heparins and warfarin (n: 264, 96%), and with an unbalanced INR level (n: 230, 87%). The use of NOACs was found to be higher in the geriatric age group than other anticoagulants due to the easy dose adjustment, the extended monitoring intervals and the low risk of bleeding. Among the physicians, neither the specialty nor a higher number of occupational working years affected the preference for NOACs or other anticoagulants. CONCLUSIONS: Our study has demonstrated that physicians consider NOACs to be a good treatment option in terms of efficacy and reliability for the treatment of thromboembolic diseases in the geriatric age group, who may have treatment compliance difficulties. It was found also that they plan treatment considering the benefit-to-harm ratio and the bleeding-ischemic event balance.

Immunization status in chronic obstructive pulmonary disease: A multicenter study from Turkey.

OBJECTIVE: The purpose of this study is to detect the prevalence and the factors associated with influenza and pneumococcal vaccination and outcomes of vaccination during 2013-2014 season in patients with chronic obstructive pulmonary disease (COPD) in Turkey. METHODS: This was a multicenter retrospective cohort study performed in 53 different centers in Turkey. RESULTS: During the study period, 4968 patients were included. COPD was staged as GOLD 1-2-3-4 in 9.0%, 42.8%, 35.0%, and 13.2% of the patients, respectively. Influenza vaccination rate in the previous year was 37.9%; and pneumococcus vaccination rate, at least once during in a life time, was 13.3%. Patients with older age, higher level of education, more severe COPD, and comorbidities, ex-smokers, and patients residing in urban areas had higher rates of influenza vaccination. Multivariate logistic regression analysis showed that advanced age, higher education levels, presence of comorbidities, higher COPD stages, and exacerbation rates were associated with both influenza and pneumococcal vaccination. The number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was 2.73 ± 2.85 and 0.92 ± 1.58 per year, respectively. Patients with older age, lower education levels, more severe COPD, comorbid diseases, and lower body mass index and patients who are male and are residing in rural areas and vaccinated for influenza had significantly higher rates of COPD exacerbation. CONCLUSIONS: The rates of influenza and pneumococcal vaccination in COPD patients were quite low, and the number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was high in Turkey. Advanced age, higher education levels, comorbidities, and higher COPD stages were associated with both influenza and pneumococcal vaccination.

Prognostic importance of central thrombus in hemodynamically stable patients with pulmonary embolism.

BACKGROUND: The association between mortality and localization of central thrombus in hemodynamically stable patients with pulmonary embolism (PE) is unclear. Sufficient data are not available to help clinicians to select between low molecular weight heparin (LMWH), unfractionated heparin (UFH) and thrombolytics for the management of central thrombus. The present study aims to investigate whether central thrombus in the pulmonary artery affects 30-day mortality rate, and to compare the outcomes of different treatment approaches in patients with central thrombus. METHODS: This multi-central, prospective, observational study included 874 hemodynamically stable patients with PE confirmed by multidetector computed tomography scan. The localization of the emboli was evaluated and categorized as central (saddle or at least one main pulmonary artery), lobar or distal. The primary study outcome was 30-day all-cause mortality. RESULTS: Localization of the emboli was central in 319 (36.5%) patients, lobar in 264 (30.2%) and distal in 291 (33.2%) patients. Seventy-four (8.5%) patients died during the 30-day follow-up period. All-cause mortality rate was 11.9%, 6.8% and 6.2% in patients with central, lobar, and distal emboli, respectively (p < 0.001). Multivariate analysis did not show that hemodynamically stable central thrombus was an independent predictor of mortality. Additionally, mortality rate was not significantly different between UFH, LMWH and thrombolytic therapy groups. CONCLUSIONS: The present study showed that central thrombus was not an independent predictor of mortality in hemodynamically stable PE patients. LMWH and UFH were similarly effective in the treatment of this patient group.

[Epigenetic and current treatment approaches in chronic obstructive pulmonary disease]. / Kronik obstrüktif akciger hastaliginda epigenetik ve güncel tedavi yaklasimlari.

Epigenetics mechanisms such as DNA methylation, histone acetylation and non-coding RNAs may play are a role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Researchs with regard epigenetic in COPD can shed light on pathogenes and may be relevant in the development of novel targeted therapies. The aim of this article is to review epigenetic mechanisms new treatments approaches in COPD.

YKL-40: may be use as a new inflammatory biomarker in obstructive sleep apnea syndrome?

INTRODUCTION: YKL-40 [chitinase-3 like-1 (CHI3L1)] is a glycoprotein, has been implicated in inflammation, endothelial dysfunction, tissue remodelling and it is accepted as a noninvasive prognostic biomarker for inflammation. In this study, we aimed to underline usability of serum YKL-40 as an inflammatory biomarker in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Two groups OSAS patients [Group I: Mild-moderate OSAS, n:43; median apnea-hypopnea index: AHI, /hour:18], Group II: Severe OSAS, n: 25; AHI:41.6] and healthy control group [n:25, AHI: 3.6] were included in the study. Serum YKL-40 level was tested in serum samples taken after polysomnography in OSAS patients and control group. In addition, the association of serum YKL-40 level with age, body mass index and polysomnografic parameters were analyzed in the OSAS patient groups. RESULTS: Median serum YKL-40 level was 20.30 ng/mL (range 8.01-73 ng/mL) in mild-moderate OSAS patients, and 22.58 ng/mL (9.17-99 ng/mL in severe OSAS patients, 18 ng/mL (range 7.36-88 ng/mL) in control group (p< 0.05). Serum YKL-40 level was found to be correlated with AHI in patient with mild-moderate OSAS patients (p< 0.05) and serum YKL-40 level was found to be correlated with age, total hypopnea time (minutes) in severe OSAS patients (p< 0.05). There was no relationship serum YKL-40 level with other studied variables (p> 0.05). CONCLUSION: At the end of this study, we found that serum YKL-40 level increase with severity of OSAS. The findings suggest that YKL-40 may be a useful biomarker for inflammation in patients with OSAS.

Clinical update on pulmonary embolism.

Pulmonary embolism (PE) is a major cause of cardiovascular mortality and financial burden that affects the community. The diagnosis of PE can be difficult because of the nonspecific symptoms, which include cough, dyspnea, hemoptysis and pleuritic chest pain. Hereditary and acquired risk factors are associated with PE. Incidence of PE is increasing, associated with the development in the diagnostic methods. Evidence-based algorithms can help clinicians diagnose PE. Serum D-dimer level, computed tomography pulmonary angiogram (CTPA), ventilation-perfusion scintigraphy or echocardiography help to establish clinical probability and the severity of PE. Anticoagulation is the standard treatment for PE. However, thrombolytic treatment is a significant alternative in high risk of PE as it provides rapid clot resolution. This article reviews the risk factors, diagnostic algorithms, and methods of treatment in PE in the light of current information.

[Asthma, environment and epigenetic]. / Astim, çevre ve epigenetik.

Epigenetic defines long-lasting changes in gene expression independently from DNA sequence. Current evidence revealed that epigenetic mechanisms may have role into immune response and asthma. The purpose of this article is to review basic epigenetic mechanisms in asthma.

The relationship between serum YKL-40 levels and severity of asthma.

YKL-40 (chitinase-3-like-1) has been introduced as a marker of inflammation in asthma. The aim of this study was to determine the role of YKL-40 in asthma and to evaluate the relationship between YKL-40 and asthma severity.In the study, 60 non-smoker asthma patients without additional diseases (aged between 20-60 years, female: 34) were grouped [Group I: Well controlled asthma patients (n: 30), Group II: Patients during acute exacerbation of asthma (n: 30)]. Healthy non-smoker female individuals were included in Group III (n: 30) as a control group. The level of serum YKL-40 of all groups were determined by ELISA. Also, serum YKL- 40 level was correlated with age, asthma duration in years, body mass index (BMI), forced expiratory volume in first second/ forced vital capacity (FEV1/FVC, %), FEV1 (%), and total IgE levels of asthma patients. Mean serum YKL-40 level was highest in patients during acute exacerbation of asthma (36.36±10.49 ng/ml) while mean serum YKL-40 level was the lowest (13.20±5.60 ng/ml) in the control group. There was a negative significant correlation between the serum YKL-40 levels and FEV1 (%) in patients during acute exacerbation of asthma. There were no significant correlations between the serum YKL-40 levels and other variables in group II.We found that increased serum YKL-40 levels may be used as a marker for evaluation of asthma severity and genetic polimorphism.

Chitinases and lung diseases.

Chitinase enzymes that hydrolize chitin and some articficial substrates are expressed in human despite lacking of the endogenous chitin within the body. Chitinases phatophysiological functions within human are not fully known. Recent evidence revealed that chitinases may have role into some processes of immune responses and inflammatory system. In this review, we discuss the role of chitinases in lung diseases based on the available information from the literature.

General Characteristics and Prognostic Factors of Pneumonia Cases Developed During Pandemic (H1N1) Influenza-A Virus Infection in Turkey.

OBJECTIVE: Unlike seasonal influenza, seen in previous years, the strain identified in the 2009 influenza-A pandemic involved high mortality. In this study, prognostic factors and general characteristics of pneumonia cases developed in Turkey during the H1N1 pandemic between October 2009 and January 2010 were analyzed. STUDY DESIGN: Multicenter retrospective study. MATERIAL AND METHODS: This multicentric retrospective study was conducted between August and October 2010 and patients' data were collected by means of standard forms. RESULTS: The study included 264 pneumonia cases, collected from 14 different centers. Mean age was 47.5±18.6 years. Nineteen patients (7.2%) were pregnant or had a new birth and comorbid diseases were detected in 52.3% of all patients. On admission, 35 (13.8%) cases had altered mental status. Overall, 32.6% were treated in intensive care units (ICU) and invasive/non-invasive mechanical ventilation was performed in 29.7%. The mean duration of ICU stay was 2.9±6.2 and total hospital stay was 12.0±9.4 days. Mortality rate was 16.8% (43-cases). The length of ICU treatment, total hospital stay, and mortality were significantly higher in H1N1-confirmed patients. Mortality was significantly higher in patients with dyspnea, cyanosis, and those who had altered mental status on admission. Patients who died had significantly higher rate of peripheral blood neutrophils, lower platelet counts, higher BUN, and lower SaO2 levels. CONCLUSION: This study showed that pneumonia developed during H1N1 pandemic in our country had resulted in a high mortality. Mortality was especially high among patients with cyanosis, altered mental state and those with lower SaO2.

Serum S100B protein: a useful marker in obstructive sleep apnea syndrome.

BACKGROUND AND PURPOSE: We aimed to underline the importance of serum S100B protein as a useful biochemical marker in patients with obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: Forty-three newly diagnosed patients with OSAS (median apnea-hypopnea index [AHI, events/ hour]: 37.5 [range 11.3-137]) and 25 subjects with AHI < 5 (median AHI: 4.4 [range 0.7-4.8]) were included in the study. Serum S100B protein level was tested in serum samples taken after polysomnography in both groups and the difference between OSAS patients and the control group regarding that level was assessed. In addition, the association of S100B protein serum level with age, body mass index, AHI, mean O2 saturation percentage during sleep, minimum O2 saturation value (%) at the end of the apneas, and the time spent at an O2 saturation less than 90% were analyzed in the OSAS patient group. RESULTS: Median serum S100B protein level was 133.7 pg/ mL (range 20.97-230.70 pg/mL) in patients with OSAS and 16.1 pg/mL (range 10.1-22.9 pg/mL) in the control group (p < 0.005). Serum S100B protein level did not correlate with any studied variable (p > 0.05 for each correlation coefficient). CONCLUSIONS: Serum S100B protein level is increased in patients with OSAS and may be a useful biochemical marker in those patients.

[Clinical, laboratory and computed tomography pulmonary angiography results in pulmonary embolism: retrospective evaluation of 205 patients]. / Pulmoner embolide klinik, laboratuvar ve bilgisayarli tomografi pulmoner anjiyografi sonuçlari: 205 hastanin retrospektif degerlendirmesi.

OBJECTIVE: With this study, we aimed at evaluating demographic data, clinical, laboratory findings in pulmonary embolism (PE) and the relationship of these findings with the embolism location region and responses of the patients to the treatment of the embolism in order to contribute to the patient management in decreasing mortality. METHODS: Clinical findings, accompanying diseases, risk factors, serum D-dimer and creatinine levels, imaging modalities and mortality rates of 205 patients (female: 98, male: 107) diagnosed with PE were examined retrospectively. The relationship between the qualifier variables was evaluated using Chi-square test. RESULTS: Average age of the patients was 61.55±14.44 years and 86 (42%) patients were above 65 years. Most common complaint was dyspnea (85%), most frequent coexisting disease was congestive heart failure (19%). Deep vein thrombosis (DVT) (30.7%) was the most frequently seen risk factor. Pulmonary embolism was mostly in the right lobe pulmonary artery (32.1%). It was observed that the higher ages of patients the more frequency of proximal located embolism was (p<0.005), especially lobar artery involvement was observed to be high (p=0.032). An early mortality rate was 4.9% and late mortality rate was 11.2%. CONCLUSION: In the patients with complaint of dyspnea who are at elder ages and have accompanying diseases, PE should be considered. PE is generally localized in the main pulmonary arteries, which emphasizes crucial importance of early diagnosis and treatment in reduction of mortality.

Hepcidin: A useful marker in chronic obstructive pulmonary disease.

PURPOSE: This study was designed to evaluate the levels of hepcidin in the serum of patients with chronic obstructive pulmonary disease (COPD). METHODS: In the study, 74 male patients (ages 45-75) in a stable period for COPD were grouped as Group I: Mild COPD (n:25), Group II: Moderate COPD (n:24), and Group III: Severe COPD (n:25). Healthy non-smoker males were included in Group IV (n:35) as a control group. The differences of hepcidin level among all the groups were examined. Also, in the patient groups with COPD, hepcidin level was compared with age, body mass index, cigarette (package/year), blood parameters (iron, total iron binding capacity, ferritin, hemoglobin, hematocrit [hct]), respiratory function tests, and arterial blood gas results. RESULTS: Although there was no difference between the healthy control group and the mild COPD patient group (P=0.781) in terms of hepcidin level, there was a difference between the moderate (P=0.004) and the severe COPD patient groups (P=0.002). The hepcidin level of the control group was found to be higher than the moderate and severe COPD patient groups. In the severe COPD patients, hepcidin level increased with the increase in serum iron (P=0.000), hct (P=0.009), ferritin levels (P=0.012), and arterial oxygen saturation (SaO(2), P=0.000). CONCLUSION: The serum hepcidin level that is decreased in severe COPD brings into mind that it may play a role in the mechanism to prevent hypoxemia. The results suggest that serum hepcidin level may be a useful marker in COPD. Larger prospective studies are needed to confirm our findings between hepcidin and COPD.